The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis

PURPOSE: It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism. MATERIALS AND METHODS: Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertalpatients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score. RESULTS: Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5. CONCLUSIONS: Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.

The Comparison between Transperineal and Transrectal Ultrasound-Guided Prostate Needle Biopsy

PURPOSE: Prostate biopsy is a conventional method for the detection of prostate cancer in men with suspicious findings. However, there is no universal agreement on which method is the better approach to the prostate, with regard to cancer detection rate and complication rate. In this prospective randomized study, we compared cancer detection rates and complication rates between transperineal (TP) and transrectal (TR) prostate biopsy. MATERIALS AND METHODS: Between March 2006 and December 2007, we analyzed 200 Korean men. One hundred patients underwent randomized TP prostate biopsy and 100 patients underwent TR prostate biopsy. All biopsies were extended 12-core biopsies. With both approaches, 12 biopsy specimens were obtained systematically from the peripheral and transitional zones, including the apex, base, and transitional zone. The patient's subjective pain scale was measured by use of visual analogue scales. Immediately after the biopsy, the pain score was independently recorded by the patients. One week later, various complications were measured by answer note. RESULTS: The overall cancer detection rate was 22% (22 of 100 patients) with TR prostate biopsy and 29% (29 of 100 patients) with TP prostate biopsy. Considering the prostate cancer detection rate, there were no significant differences between the groups for prostate-specific antigen (PSA), age, body mass index (BMI), and prostate volume. Apart from the cancer detection rate and complication rate, the pain scale, in each different approach, was statistically meaningful. CONCLUSIONS: There were no significant differences in the cancer detection rate or complication rate between TP and TR prostate needle biopsy. However, with regard to pain relief and complication rates, TR prostate needle biopsy is preferable.

Effects of Metabolic Syndrome on Chronic Kidney Disease

PURPOSE: Metabolic syndrome (MS) has been identified as a causal risk factor for cardiovascular disease, stroke, and cardiovascular mortality. Recent studies have suggested a possible relation between MS and renal function. The aim of this study was to evaluate the influence of MS on renal function. MATERIALS AND METHODS: We analyzed 12,348 healthy Koreans who underwent a general health checkup. MS was defined as 3 or more of the criteria according to the National Cholesterol Education Program Adult Treatment Panel guidelines III (NCEP ATP III). The glomerular filtration rate (GFR) was estimated by the redefined Modification of Diet in Renal Disease formula. Chronic kidney disease (CKD) was categorized into 3 categories according to the Kidney Disease: Improving Global Outcomes guidelines; I: GFR> or =90 ml/min, II: 60-89 ml/min, III: 30-59 ml/min. RESULTS: The overall proportion with MS was 19.3%. Compared with populations without MS, those with MS showed a significantly decreased GFR. The prevalence of CKD increased with the number of MS components, and it was prominent in the group of males over 40 years of age. In multivariate analyses using age, sex, and individual MS components, age (odds ratio [OR]=20.40; 95% CI: 10.81-38.49), sex (OR=1.98; 95% CI: 1.51-2.60), and obesity (OR=1.48; 95% CI: 1.13-1.93) were strongly associated with CKD. CONCLUSIONS: This study showed that MS is a significant determinant of CKD. Handling of correctable factors such as obesity may be considered one of the preventive modalities against the development of CKD.

Clinical Significance of the Expression of Gli2 and Gli3 in Bladder Cancer / 대한비뇨기과학회지

PURPOSE: The HedgehogGli(HHGli) signaling pathway controls many aspects of tissue patterning, cell proliferation, differentiation and regeneration, and regulates the number of cells in various organs. Inappropriate and uncontrolled activation of the HHGli signaling pathway has been demonstrated in a variety of human cancers. The Gli1, Gli2, and Gli3 genes encoding the Gli family transcription factors play a role as HH effectors. This study examined the significance in Gli2 and Gli3 expression in human bladder cancer. MATERIALS AND METHODS: The tumor tissues were obtained from 144 patients with a primary bladder cancer. The mRNA levels of Gli2, and Gli3 were examined using a real-time polymerase chain reaction(PCR) assay in 144 tumor specimens, and immunohistochemical staining was performed on 127 tumor paraffin blocks. The relationships between their expression and the pathological or clinical characteristics, such as tumor stage, grade, recurrence and progression were also analyzed. RESULTS: Gli2 mRNA expression was higher in the invasive bladder tumors than in the superficial bladder tumors(p<0.001) but, there was no difference in Gli3 mRNA expression according to the tumor stage and grade. The multivariate Cox regression model revealed that Gli2 mRNA expression(hazards ratio(HR): 2.329, 95% confidence interval(CI): 1.043- 5.202, p=0.039) was the only strong predictor of superficial bladder tumor recurrence. Kaplan-Meier analysis also showed identical results (log-rank test, p=0.043). CONCLUSIONS: The enhanced expression of Gli2 mRNA was strongly correlated with the recurrence of superficial bladder cancer. These results suggest that Gli2 may be a useful marker for assessing the recurrence of superficial bladder cancer in human bladder cancers.